Azithromycin

Description
Azithromycin is an azalide, a subclass of macrolide antibiotics, for intravenous
injection and oral use. It is supplied for oral administration as film-coated, modified capsular
shaped tablets containing azithromycin dihydrate equivalent to either 250 mg or 500 mg
azithromycin and for injection it’s supplied in lyophilized from in a 10 ml single dose vial,
containing an equivalent of 500 mg azithromycin for intravenous administration.
Azithromycin is derived from erythromycin; however, it differs chemically from
erythromycin in that a methyl-substituted nitrogen atom is incorporated into the lactone
ring.
Azithromycin has the chemical name (2R,3S,4R,5R,8R,10R,11R,12S,13S,14R)-13-
[(2,6-dideoxy-3-C-methyl-3-O-methyl-α-L ribohexopyranosyl) oxy]-2-ethyl-3,4,10-
trihydroxy-3,5,6,8,10,12,14-hepta-methyl-11-[[3,4,6-trideoxy-3- (dimethylamino)-ß-D-
xylo-hexopyranosyl]oxy]-1-oxa-6-azacyclopentadecan-15-one.

Pharmacology
As described earlier, it is a sub class of macrolide antibiotics. It has the ability to
block protein synthesis. Azithromycin acts by binding to the 50S ribosomal subunit of
susceptible microorganisms and, thus, interfering with microbial protein synthesis.
Nucleic acid synthesis is not affected.

Pharmacokinetics
Azithromycin is absorbed both widely and rapidly throughout the body. When
distributed in the body, concentrations are found to be greater in tissue compared to
that of plasma and serum levels. Due to azithromycin’s high oral bioavailability, long
half-life, and ability to attain high tissue concentrations, it lends itself to a once daily
dosing regimen. The drug is metabolized in the liver and excreted in the urine.

Uses of azithromycin
 The drug is primarily bacteriostatic, but can be bactericidal depending on the
concentration given. It is effective against aerobic Gram-positive microorganisms, and
some Gram-negative organisms. However, azithromycin does not appear to have any
inherent direct activity against Pseudomonas aeruginosa (a Gram-negative, rod-shaped,
opportunistic pathogen).
This antibiotic treats only bacterial infections. It will not work for viral infections
(e.g., common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its
decreased effectiveness.

Used for the following indications:

 Community-acquired pneumonia due to Chlamydia pneumonia, Haemophilus
influenzae, Legionella pneumophila, Moraxella catarrhalis, Mycoplasma
pneumoniae, Staphylococcus aureus, or Streptococcus pneumoniae
 Pelvic inflammatory disease due to Chlamydia trachomatis, Neisseria
gonorrhoea, or Mycoplasma hominis
 Sexually Transmitted Diseases and Non-gonococcal urethritis and cervicitis due
to Chlamydia trachomatis
 Acute bacterial exacerbations of chronic obstructive pulmonary disease due to
Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumonia
 Pharyngitis/tonsillitis caused by Streptococcus pyogenes
 Genital ulcer disease in men due to Haemophilus ducreyi

Adverse drug reactions:

In the clinical studies less than 1% of the total population reported the adverse
reactions. The most common ones were dyspepsia, flatulence, mucositis, headache,
somnolence, bronchospasm and nausea. During the post marketing experience of the
drug the adverse events were asthenia, diarrhoea, anorexia, dyspepsia, mucositis,
allergic reactions etc. A few reported about arrhythmias and thrombocytopenia.

Dosage: No dosage adjustment is recommended based on age or gender in adults. In paediatric

the dose should be given by recommendation of the physician.
Drug interactions and contraindications:

 Contraindicated in patients with known hypersensitivity to azithromycin,

erythromycin, or any macrolide antibiotic.
